|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$1,336.18
|
|
|
Service Code
|
CPT 11421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$567.88 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$607.96
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$3,076.96
|
|
|
Service Code
|
CPT 11422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$657.03 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$3,076.96
|
|
|
Service Code
|
CPT 11423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS
|
Facility
|
OP
|
$1,336.18
|
|
|
Service Code
|
CPT 11400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$349.43 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$607.96
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$1,336.18
|
|
|
Service Code
|
CPT 11403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$567.88 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$607.96
|
|
|
EXCISION BREAST LESION
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
6119125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.62 |
| Max. Negotiated Rate |
$7,272.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$570.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,502.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,982.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,636.05
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cigna Commercial |
$808.35
|
| Rate for Payer: First Health Commercial |
$855.90
|
| Rate for Payer: First Health Workers Compensation |
$367.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.90
|
| Rate for Payer: GEHA Commercial |
$760.80
|
| Rate for Payer: GEHA Medicare |
$3,636.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.90
|
| Rate for Payer: Humana ChoiceCare |
$3,999.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,636.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,108.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,022.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,636.05
|
| Rate for Payer: Multiplan All |
$865.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,181.28
|
| Rate for Payer: OMNI Networks Commercial |
$665.70
|
| Rate for Payer: One Health Plan PPO/POS |
$855.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,335.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,022.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,636.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$903.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,272.10
|
| Rate for Payer: Three Rivers Provider Network All |
$713.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,563.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,022.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,636.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$884.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,636.05
|
| Rate for Payer: Zelis Auto |
$380.40
|
| Rate for Payer: Zelis Medicare |
$3,090.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,363.26
|
| Rate for Payer: Zelis Worker's Compensation |
$259.62
|
|
|
EXCISION BREAST LESION
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
6119125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.62 |
| Max. Negotiated Rate |
$903.45 |
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cigna Commercial |
$808.35
|
| Rate for Payer: First Health Commercial |
$855.90
|
| Rate for Payer: First Health Workers Compensation |
$367.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.90
|
| Rate for Payer: GEHA Commercial |
$665.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.90
|
| Rate for Payer: Multiplan All |
$865.41
|
| Rate for Payer: OMNI Networks Commercial |
$665.70
|
| Rate for Payer: One Health Plan PPO/POS |
$855.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$903.45
|
| Rate for Payer: Three Rivers Provider Network All |
$713.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$884.43
|
| Rate for Payer: Zelis Auto |
$380.40
|
| Rate for Payer: Zelis Worker's Compensation |
$259.62
|
|
|
EXCISION CHEST WALL TUMOR INCLUDING RIBS
|
Facility
|
OP
|
$3,726.00
|
|
|
Service Code
|
CPT 21601
|
| Hospital Charge Code |
6121601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,017.20 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,478.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,235.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,478.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,755.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$2,235.60
|
| Rate for Payer: Cash Price |
$2,235.60
|
| Rate for Payer: Cigna Commercial |
$3,167.10
|
| Rate for Payer: First Health Commercial |
$3,353.40
|
| Rate for Payer: First Health Workers Compensation |
$1,438.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,353.40
|
| Rate for Payer: GEHA Commercial |
$2,980.80
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,353.40
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,811.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$3,390.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,608.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,353.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,246.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,811.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,539.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,794.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,811.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,465.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$1,490.40
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$1,017.20
|
|
|
EXCISION CHEST WALL TUMOR INCLUDING RIBS
|
Facility
|
IP
|
$3,726.00
|
|
|
Service Code
|
CPT 21601
|
| Hospital Charge Code |
6121601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,017.20 |
| Max. Negotiated Rate |
$3,539.70 |
| Rate for Payer: Cash Price |
$2,235.60
|
| Rate for Payer: Cigna Commercial |
$3,167.10
|
| Rate for Payer: First Health Commercial |
$3,353.40
|
| Rate for Payer: First Health Workers Compensation |
$1,438.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,353.40
|
| Rate for Payer: GEHA Commercial |
$2,608.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,353.40
|
| Rate for Payer: Multiplan All |
$3,390.66
|
| Rate for Payer: OMNI Networks Commercial |
$2,608.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,353.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,539.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,794.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,465.18
|
| Rate for Payer: Zelis Auto |
$1,490.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,017.20
|
|
|
EXCISION CH WAL TUM W/RIB W/MEDSTNL LYMP
|
Facility
|
OP
|
$5,507.00
|
|
|
Service Code
|
CPT 21603
|
| Hospital Charge Code |
6121603
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,376.75 |
| Max. Negotiated Rate |
$5,231.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,304.20
|
| Rate for Payer: Cash Price |
$3,304.20
|
| Rate for Payer: Cigna Commercial |
$4,680.95
|
| Rate for Payer: First Health Commercial |
$4,956.30
|
| Rate for Payer: First Health Workers Compensation |
$2,126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,956.30
|
| Rate for Payer: GEHA Commercial |
$4,405.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,956.30
|
| Rate for Payer: Humana ChoiceCare |
$1,431.82
|
| Rate for Payer: Multiplan All |
$5,011.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,304.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,854.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,956.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,231.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,130.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,846.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,376.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,121.51
|
| Rate for Payer: Zelis Auto |
$2,202.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,753.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,503.41
|
|
|
EXCISION CH WAL TUM W/RIB W/MEDSTNL LYMP
|
Facility
|
IP
|
$5,507.00
|
|
|
Service Code
|
CPT 21603
|
| Hospital Charge Code |
6121603
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,503.41 |
| Max. Negotiated Rate |
$5,231.65 |
| Rate for Payer: Cash Price |
$3,304.20
|
| Rate for Payer: Cigna Commercial |
$4,680.95
|
| Rate for Payer: First Health Commercial |
$4,956.30
|
| Rate for Payer: First Health Workers Compensation |
$2,126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,956.30
|
| Rate for Payer: GEHA Commercial |
$3,854.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,956.30
|
| Rate for Payer: Multiplan All |
$5,011.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,854.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,956.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,231.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,130.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,121.51
|
| Rate for Payer: Zelis Auto |
$2,202.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,503.41
|
|
|
EXCISION CH WAL TUM W/RIB W/O MEDSTNL LY
|
Facility
|
OP
|
$4,963.00
|
|
|
Service Code
|
CPT 21602
|
| Hospital Charge Code |
6121602
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,240.75 |
| Max. Negotiated Rate |
$4,714.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,977.80
|
| Rate for Payer: Cash Price |
$2,977.80
|
| Rate for Payer: Cigna Commercial |
$4,218.55
|
| Rate for Payer: First Health Commercial |
$4,466.70
|
| Rate for Payer: First Health Workers Compensation |
$1,916.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,466.70
|
| Rate for Payer: GEHA Commercial |
$3,970.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,466.70
|
| Rate for Payer: Humana ChoiceCare |
$1,290.38
|
| Rate for Payer: Multiplan All |
$4,516.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,977.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,474.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,466.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,714.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,722.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,367.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,240.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,615.59
|
| Rate for Payer: Zelis Auto |
$1,985.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,481.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,354.90
|
|
|
EXCISION CH WAL TUM W/RIB W/O MEDSTNL LY
|
Facility
|
IP
|
$4,963.00
|
|
|
Service Code
|
CPT 21602
|
| Hospital Charge Code |
6121602
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,354.90 |
| Max. Negotiated Rate |
$4,714.85 |
| Rate for Payer: Cash Price |
$2,977.80
|
| Rate for Payer: Cigna Commercial |
$4,218.55
|
| Rate for Payer: First Health Commercial |
$4,466.70
|
| Rate for Payer: First Health Workers Compensation |
$1,916.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,466.70
|
| Rate for Payer: GEHA Commercial |
$3,474.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,466.70
|
| Rate for Payer: Multiplan All |
$4,516.33
|
| Rate for Payer: OMNI Networks Commercial |
$3,474.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,466.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,714.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,722.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,615.59
|
| Rate for Payer: Zelis Auto |
$1,985.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,354.90
|
|
|
EXCISION CONSTRICTING TISSUE
|
Facility
|
IP
|
$1,501.00
|
|
|
Service Code
|
CPT 26596
|
| Hospital Charge Code |
6126596
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.77 |
| Max. Negotiated Rate |
$1,425.95 |
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$1,275.85
|
| Rate for Payer: First Health Commercial |
$1,350.90
|
| Rate for Payer: First Health Workers Compensation |
$579.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.90
|
| Rate for Payer: GEHA Commercial |
$1,050.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.90
|
| Rate for Payer: Multiplan All |
$1,365.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.93
|
| Rate for Payer: Zelis Auto |
$600.40
|
| Rate for Payer: Zelis Worker's Compensation |
$409.77
|
|
|
EXCISION CONSTRICTING TISSUE
|
Facility
|
OP
|
$1,501.00
|
|
|
Service Code
|
CPT 26596
|
| Hospital Charge Code |
6126596
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.77 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$900.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$1,275.85
|
| Rate for Payer: First Health Commercial |
$1,350.90
|
| Rate for Payer: First Health Workers Compensation |
$579.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.90
|
| Rate for Payer: GEHA Commercial |
$1,200.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,365.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$600.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$409.77
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR PRI
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 25111
|
| Hospital Charge Code |
20300061
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$269.18 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$838.10
|
| Rate for Payer: First Health Commercial |
$887.40
|
| Rate for Payer: First Health Workers Compensation |
$380.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$887.40
|
| Rate for Payer: GEHA Commercial |
$788.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$887.40
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$897.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$690.20
|
| Rate for Payer: One Health Plan PPO/POS |
$887.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$936.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$739.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$394.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$269.18
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR PRI
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 25111
|
| Hospital Charge Code |
6125111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.18 |
| Max. Negotiated Rate |
$936.70 |
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$838.10
|
| Rate for Payer: First Health Commercial |
$887.40
|
| Rate for Payer: First Health Workers Compensation |
$380.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$887.40
|
| Rate for Payer: GEHA Commercial |
$690.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$887.40
|
| Rate for Payer: Multiplan All |
$897.26
|
| Rate for Payer: OMNI Networks Commercial |
$690.20
|
| Rate for Payer: One Health Plan PPO/POS |
$887.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$936.70
|
| Rate for Payer: Three Rivers Provider Network All |
$739.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.98
|
| Rate for Payer: Zelis Auto |
$394.40
|
| Rate for Payer: Zelis Worker's Compensation |
$269.18
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR PRI
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 25111
|
| Hospital Charge Code |
6125111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.18 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$838.10
|
| Rate for Payer: First Health Commercial |
$887.40
|
| Rate for Payer: First Health Workers Compensation |
$380.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$887.40
|
| Rate for Payer: GEHA Commercial |
$788.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$887.40
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$897.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$690.20
|
| Rate for Payer: One Health Plan PPO/POS |
$887.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$936.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$739.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$394.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$269.18
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR PRI
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 25111
|
| Hospital Charge Code |
20300061
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$269.18 |
| Max. Negotiated Rate |
$936.70 |
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$838.10
|
| Rate for Payer: First Health Commercial |
$887.40
|
| Rate for Payer: First Health Workers Compensation |
$380.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$887.40
|
| Rate for Payer: GEHA Commercial |
$690.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$887.40
|
| Rate for Payer: Multiplan All |
$897.26
|
| Rate for Payer: OMNI Networks Commercial |
$690.20
|
| Rate for Payer: One Health Plan PPO/POS |
$887.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$936.70
|
| Rate for Payer: Three Rivers Provider Network All |
$739.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.98
|
| Rate for Payer: Zelis Auto |
$394.40
|
| Rate for Payer: Zelis Worker's Compensation |
$269.18
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR REC
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 25112
|
| Hospital Charge Code |
6125112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.05 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: First Health Workers Compensation |
$462.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$958.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$327.05
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR REC
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 25112
|
| Hospital Charge Code |
20300062
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$327.05 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: First Health Workers Compensation |
$462.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Worker's Compensation |
$327.05
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR REC
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 25112
|
| Hospital Charge Code |
6125112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.05 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: First Health Workers Compensation |
$462.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Worker's Compensation |
$327.05
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR REC
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 25112
|
| Hospital Charge Code |
20300062
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$327.05 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: First Health Workers Compensation |
$462.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$958.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$327.05
|
|
|
EXCISION HAND/FINGER TENDON
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 26415
|
| Hospital Charge Code |
6126415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.87 |
| Max. Negotiated Rate |
$1,450.65 |
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cigna Commercial |
$1,297.95
|
| Rate for Payer: First Health Commercial |
$1,374.30
|
| Rate for Payer: First Health Workers Compensation |
$589.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,374.30
|
| Rate for Payer: GEHA Commercial |
$1,068.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,374.30
|
| Rate for Payer: Multiplan All |
$1,389.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,374.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,450.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,145.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,420.11
|
| Rate for Payer: Zelis Auto |
$610.80
|
| Rate for Payer: Zelis Worker's Compensation |
$416.87
|
|
|
EXCISION HAND/FINGER TENDON
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 26415
|
| Hospital Charge Code |
6126415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.87 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$916.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cigna Commercial |
$1,297.95
|
| Rate for Payer: First Health Commercial |
$1,374.30
|
| Rate for Payer: First Health Workers Compensation |
$589.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,374.30
|
| Rate for Payer: GEHA Commercial |
$1,221.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,374.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,389.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,068.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,374.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,450.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,145.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,420.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$610.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$416.87
|
|
